Electron Microscopy in Determining Origin of Metastatic Adenocarcinomas

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Abstract
Light microscopy has limited value in predicting where the primary site of a metastatic adenocarcinoma might be located. EM was useful in determining the primary site in .apprx. 85% of patients with a metastatic adenocarcinoma of unknown origin. This study is based on the ultrastructural examination of > 100 such cases. In the remaining 15% of the cases, EM usually provided assistance in reducing the differential diagnosis to a minimum, usually to 2 possible primary sites. The majority of the metastatic adenocarcinomas showed rather specific ultrastructural features to suggest the site of origin. This application of EM has never been fully explored; it has considerable clinical importance and economic impact in health care systems. An extensive work-up to determine the primary site, with its inconvenience to patient and family, as well as delay in adequate treatment, can be avoided with early diagnosis of the primary site.